Registration
4 openings left in this event!
An evening of fun for everyone!
OPEN TO THE PUBLIC
TIME: 6:00-10:30pm
Cost: $30 for the first child, $15 for siblings
***Sibling discount will be applied after reviewing***
PIZZA PARTY, GAMES, DANCING, MUSIC, OBSTACLE COURSES, CRAFTS and MORE!
Who is invited to participate: Any child ages 4 -12 throughout the community.
Event:
Start Date/Time: End Date/Time:
Fee per Student: Room:
* - denotes required fields
Family Information
First Name:* Last Name: *
Type*
Home Phone: Cell #: Work #:
Email:* (Emails are kept confidential)
 
Address: *
City: * State: * Zip: *
Emergency Contact Info*
 
 
Students entered below will be added to your family's account
 
Questions/Options:
Does your child (children) have any allergies?
Comments/Questions?
 
Additional Information:
 
Injuries/Liability Waiver
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I've read the above and agree.
 
Media Release
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I've read the above and agree.
 
Enter your Full Name: *   
 
Other Questions/Comments:
 
Credit Card Verification:
   
Card Number: *  
Name as it appears on card: *
Nickname:
Card Expiration Month: *   Exp Year: *
Address Line 1: Address Line 2:
City: State: Zip:*